Abstract
Focal lesions of brainstem, thalamus, and subcortical white matter may cause movement disorders that are clinically indistinguishable from cerebellar symptoms. It is suspected that ataxia in these cases is due to damage of efferent or afferent pathways of the cerebellum. However, the precise anatomical correlate often remains undefined. We used deterministic diffusion tensor magnetic resonance imaging (DTI) tractography to study the anatomical relationship between lesions causing ataxia and efferent cerebellar pathways. Study subjects were six male patients with focal lesions of different etiology (demyelination, hemorrhage, ischemia, neoplasm) outside the cerebellum. Five patients had cerebellar-like ataxia with prominent contralateral upper limb involvement. One patient with an almost midline mesencephalic lesion had a symmetrical ataxic syndrome. We used 3T MRI (Intera, Philips Medical Systems, Best, Netherlands) and DTI tractography (32 directions, StealthViz DTI, Medtronic Navigation, Louisville, USA) to delineate the dentato-rubro-thalamo-cortical tract (DRT). In all patients, tractography demonstrated focal lesions affecting the DRT in different locations. We conclude that in vivo mapping of cerebral pathways using DTI tractography in patients with focal extracerebellar brain lesions may provide direct evidence of circumscribed damage to the DRT, causing unilateral cerebellar-like ataxia. Also, a unilateral mesencephalic lesion at the level of the crossing of the DRT may cause bilateral ataxia.
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On behalf of all authors the corresponding author states that there is no conflict of interest.
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All patients gave written consent for the MRI and the study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Supplementary material 1 (PNG 288 kb) Patient 5 with multiple sclerosis with demyelinating lesions interrupting the DRT causing contralateral postural and intention tremor as well as ataxia. This patient was successfully treated with Deep Brain Stimulation (DBS el.) also affecting the DRT. PT = pyramidal tract, DRT = dentate-rubro-thalamo-cortical tract
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Marek, M., Paus, S., Allert, N. et al. Ataxia and tremor due to lesions involving cerebellar projection pathways: a DTI tractographic study in six patients. J Neurol 262, 54–58 (2015). https://doi.org/10.1007/s00415-014-7503-8
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DOI: https://doi.org/10.1007/s00415-014-7503-8